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. 2025 Jan 9;4(2):101538.
doi: 10.1016/j.jacadv.2024.101538. eCollection 2025 Feb.

Diagnostic Accuracy of Apple Watch Electrocardiogram for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Sufyan Shahid  1 , Minahil Iqbal  2 , Humza Saeed  3 , Sara Hira  4 , Amna Batool  4 , Salman Khalid  5 , Naeem Khan Tahirkheli  5
Affiliations

Diagnostic Accuracy of Apple Watch Electrocardiogram for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Sufyan Shahid et al. JACC Adv. .

Abstract

Background: Electrocardiography (ECG) is the gold standard for the diagnosis of atrial fibrillation (AF). Recently, smartwatches like the Apple Watch have emerged as a promising, user-friendly device for rapid detection and diagnosis of AF, but the reliability and diagnostic accuracy still remain controversial.

Objectives: The purpose of this study was to perform a systematic review and diagnostic test accuracy meta-analysis evaluating the diagnostic performance of the Apple Watch ECG in detecting AF.

Methods: The literature search was conducted on PubMed, Embase, and Cochrane Library through April 2024 for studies comparing the diagnostic accuracy of Apple Watch to standard 12-lead ECG. Statistical analysis was performed using R Software version 4.4.0 and OpenMeta[Analyst]. Pooled analyses of sensitivity, specificity, and area under the receiver operating characteristic curve were determined along with their 95% CIs. The quality of studies was analyzed using the QUADAS-2 tool.

Results: The meta-analysis included 11 studies comprising 4,241 participants. Their mean age was 62.56 ± 3.92 years, and 28% of the patients were females. The pooled sensitivity and specificity of the Apple Watch for detecting AF were 94.8% (95% CI: 91.7% to 96.8%; I2 = 67%) and 95% (95% CI: 88.6% to 97.8%; I2 = 88%), respectively. The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.92-0.97).

Conclusions: The Apple Watch ECG carries high accuracy in detecting atrial fibrillation, providing a convenient diagnostic option for patients.

Keywords: Apple Watch; atrial fibrillation; atrial fibrillation screening; electrocardiogram; heart rhythm.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
PRISMA Flow Diagram of the Included Studies PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Figure 2
Figure 2
Forest Plots for the Pooled Sensitivity and Specificity of the Studies (A) Forest plots for pooled sensitivity of the studies. Horizontal lines represent 95% CIs of the individual studies. (B) Forest plots for pooled specificity of the studies. Horizontal lines represent 95% CIs of the individual studies. TN = true negative; FP = false positive; TP = true positive; FN = false negative.
Figure 3
Figure 3
Hierarchical Summary Receiver Operating Characteristic Curve The “data” points show performance for each study, and the “summary estimate” points represent the pooled performance. SROC = summary receiver operating characteristic.
Figure 4
Figure 4
Subgroup Analysis (A) Subgroup analysis of studies for sensitivity based on inclusion of AF participants. Horizontal lines represent 95% CIs of the individual studies. (B) Subgroup analysis for specificity based on inclusion criteria of studies. Horizontal lines represent 95% CIs of the individual studies. TN = true negative; FP = false positive; TP = true positive; FN = false negative.
Figure 5
Figure 5
Meta Regression Plot The intercept shows the relationship between the series of Apple Watches employed and the resulting diagnostic odds ratio observed.
Central Illustration
Central Illustration
Diagnostic Accuracy of Apple Watch Electrocardiogram for Atrial Fibrillation: A Systematic Review and Meta-Analysis ECG = electrocardiogram.
See this image and copyright information in PMC

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